This story about an experimental HIV vaccine gets off on the wrong foot by describing the research as “promising,” which we’ve previously flagged as one of 7 words that shouldn’t be used in medical news. Why not? As our publisher, Gary Schwitzer, wrote: “The word promising means ‘likely to be successful’ or ‘to give a basis for expecting.’ There is far too much uncertainty in medicine for this word to be applied loosely in the coverage of medicine.”
Despite this initial misstep, the story does quickly establish the preliminary nature of the research and cautions that it’s much too soon to know if the vaccine will ultimately be effective in preventing HIV infections. It also does a nice job of putting this research in context with other HIV prevention efforts that have succeeded in slowing the spread of the disease. More attention to the possible costs of a vaccine — a huge issue for the developing world countries most affected by the virus — would have rounded out this otherwise solid effort.
This new vaccine approach, if proven ultimately to be effective, safe and affordable, could make a major difference in resource-poor settings around the world. But, as we’ve written about, the field of vaccine research related to HIV is littered with huge obstacles and there are never any guarantees that drug therapies will ever be accessible to the poorest parts of the world, where the need for a vaccine might be greatest. News stories on any vaccine under development should take care to point out these obstacles.
While it might be premature to speculate about the exact costs of an experimental vaccine, offering no discussion at all is a major flaw in this story. Cost is a central, vital part to this narrative because any health technology developed to be used in the world’s poorest countries are only going to matter to those people if it is affordable.
The APPROACH trial randomly assigned 393 volunteers from five countries to receive one of seven experimental vaccines or a placebo. While the report notes that “the mosaic vaccine was the best tolerated and also capable of generating anti-HIV immune responses in all the people who received the shots,” one is tempted to ask: Compared to what? How is it possible to determine the benefits of the vaccine when we don’t have any quantitative sense of how the vaccine/ comparators performed?
That being said, the story makes it clear that these immune response results, interesting though they may be, are not the outcome that matters — and this is a very important qualifier. It also uses results from previous animal studies to suggest how the vaccine might ultimately perform in people. It does this in a way that isn’t inappropriately optimistic.
We’re on the fence with this rating but will give the benefit of the doubt.
The story says the Ad26 vaccine was the “best tolerated” of several approaches, but doesn’t tell us what may have occurred in people who didn’t tolerate it so well. The potential indirect harms of a vaccine program could also have been mentioned. The vaccine is expected to work only about 50 to 60 percent of the time, according to the researchers. If people feel less pressure to employ other proven measures to control HIV (condoms, etc) because of the vaccine, then it’s possible some harm could occur due to false reassurance.
The story gets good marks for not exaggerating what we should conclude from the available research, i.e.: “we still don’t know if the vaccine will protect humans from the virus, since the studies so far have only looked at safety and immune responses, not efficacy. And many medicines that look promising in animals, and safe in humans, don’t pan out in clinical trials focused on efficacy.”
Barouch, the lead investigator, is only identified with the vaccine center but his previous disclosures show he has licensed patents to Crucell Holland, a subsidiary of Johnson & Johnson, which is funding the current research. The extent of his financial involvement with them should’ve been made more clear.
The article mentions many of the other important public health measures to control HIV (education, public awareness campaigns, condom use, etc) and other vaccines in trials.
The story makes it clear the vaccine is still in development and not likely to be available any time soon.
What is “novel” here is the type of vaccine under development, since it attempts to encompass the diversity in HIV found around the globe. The story fairly establishes the vaccine’s novel approach.
There is little evidence of an overreliance on a news release, especially with the use of many caveats warning that this research shouldn’t be overinterpreted and the use of at least one outside source.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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